Neurodementia: an image issue

Demências: uma questão de imagem

The earlier the diagnosis is made, the better the prognosis of neurodementia. However, for this new forms of advanced imaging are required for managing diseases like Alzheimer's.

Portugal, like all developed countries, is undergoing a demographic shift, where the share of elderly population will exceed the share of young people.

Professor José Ferro, neurologist at Hospital da Luz and director of the symposium on “Mind, Cognition and Neurodegeneration”, finds that not only will fewer older people suffer from stroke, or infectious, cardiac and oncological diseases, but also these people will get sick at a later age. “As a result of better living conditions, prevention and improved medicine, it will be possible for people to live to be 80-90 years old in relatively good health, until they are hit by a neurodegenerative disease like Parkinson, which may damage their cognitive capacities, like Alzheimer, or gait”, he says.

The silent epidemic of neurodegenerative diseases is extending to the more developed parts of the World, thus putting pressure on social and health systems.

The symposium on “Mind, Cognition and Neurodegeneration” highlighted particularly the features of advanced imaging (MRI quantification, MRI with ultra-high fields, PET-CT), used to diagnose, in the initial stage, neurodegenerative diseases which interfere with cognition, like Alzheimer's.

“Today we actually know that the disease is located in the brain for many years before the clinical symptoms, like forgetfulness or behaviour which seems weird, begin to show”, José Ferro warns us.

In the field of neurodegenerative diseases there are imaging methods which can tell us that one person has a high chance of developing Alzheimer's disease in, for example, four or five years time. “Functional imaging methods allow us to identify the areas of the brain which are triggered to perform certain functions. This may cause seemingly weird behaviour, but which is what the patient can manage with the part of the brain that is not impaired...”, says José Ferro.

So, besides the important part that imaging plays in pre-clinical diagnosis of people who are not yet sick, but do have the disease, imaging is also one way of monitoring the effect of drugs and of rehabilitation techniques, as a way of assessing the patient.

Is forgetting names synonymous with Alzheimer?

Often people forget names, something that happens after the age of 50. However, José Ferro says, this should not be associated with Alzheimer's disease: “To forget markedly temporal facts, like not recalling the meal they had on the previous day, that may suggest neurodementia”.

Naturally, the earlier the disease is diagnosed, the earlier the patient can start treatment, and there is still time to educate and teach relatives and the people close to them about how to avoid behavioral changes that worsen the clinical progression of the disease.

“Much of what we do involves treating the symptoms, but as we draw closer to pre-clinical image diagnosis, novel drugs open up great prospects, and make it possible to act before the symptoms appear”, José Ferro highlights.

Existing therapies mainly treat symptoms, while new medicines are being developed to eliminate amyloid, the substance which builds up and has a toxic effect on brain cells.

At the neurology department, at Hospital da Luz, most neurodementia patients managed are around the age of 70, but increasingly, José Ferro adds, given the increase in life expectancy, as mentioned before, people in their 80s and 90s will start seeking treatment. “We wont be surprised if soon centenarians start coming to us...”, he concludes.J.P.G.